Cover Story | CE Corner
CE
innovative ways to treat sexual
problems, including issues
with arousal, desire, pain and
inability to orgasm.
Even in 2019, such top-
ics can make people blush.
Yet psychologists owe it to
their patients to update their
understanding of sex ther-
apy, experts say. “Sexuality is
part of general mental health,
CONTINUING EDUCATION and I think all psychologists
SEX THERAPY FOR have a responsibility to know
THE 21 ST CENTURY: a bit about human sexuality,”
FIVE EMERGING DIRECTIONS says clinical psychologist Zoë
Peterson, PhD, an associ-
BY KIRSTEN WEIR
ate research scientist at the
Kinsey Institute, associate
professor of counseling and
educational psychology at
Indiana University and editor
of the 2017 “Wiley Handbook
M
ore than half a century has passed since of Sex Therapy.” “While it’s
famed sex researchers William Masters, MD, useful to have a sex therapy
and Virginia Johnson began their pioneering specialization, all psycholo-
research on sexuality and sexual dysfunction. That work gists should be able to provide
laid the foundation for modern sex therapy, and some their clients some guidance
of the techniques they described in the 1960s are still about human sexuality.”
being used today, says Jennifer Vencill, PhD, a licensed Whether sex therapy is a
psychologist and certified sex therapist at the Mayo cornerstone of your practice
Clinic in Rochester, Minnesota. “They were the foremost or something you address
people in their field for a reason,” she says. only briefly, here are five
Yet times have changed since those days when developments to watch.
miniskirts could scandalize and television couples slept
in separate beds. Building on the tools described by
Masters and Johnson, a new generation of researchers
has identified novel ways to view sexuality and
1 MINDFULNESS-BASED
INTERVENTIONS
Sex therapists use a variety
of approaches to treat sexual
dysfunction. In addition to
CE credits: 1 the techniques outlined by
Learning objectives: After reading this article, Masters and Johnson, tools
CE candidates will be able to: such as cognitive-behavioral
1 . Discuss current and emerging therapies for sexual problems. therapy (CBT), emotion-based
2. Describe psychologists’ efforts to include the full span of therapy and couples commu-
human sexuality and gender identity in new therapies for sexual nication techniques have been
LAFLOR/GETTY IMAGES
challenges. the treatment mainstays for
Mindfulness-based 3. Discuss attitudes about sex and sex therapy. sexual problems. Now, mind-
therapy for sexual For more information on earning CE credit for this article, fulness-based sex therapy is
issues has been one
of the most significant go to www.apa.org/ed/ce/resources/ce-corner.aspx. increasingly recognized as an
changes in the field.
30 M O N I TO R O N P S YC H O LO G Y ● JUNE 2018 M O N I TO R O N P S YC H O LO G Y
effective intervention, many
sex therapists say. Mindful-
ness-based therapies are
exciting because they are both
effective and broadly applica-
ble to many types of sexual
problems, Peterson says.
“Mindfulness is being applied
fairly widely for arousal and
desire problems, pain during
penetration, lack of orgasm
and sexual problems following
medical conditions.”
Clinical psychologist Lori
Brotto, PhD, Canada Research
Chair in Women’s Sexual
Health and director of the
University of British Columbia
Sexual Health Laboratory, pio-
neered the use of mindfulness
for sexual dysfunction. She
first encountered mindful-
ness during her psychology
residency and postdoctoral
training in 2002 and 2003,
while working with people
with parasuicidal behaviors
(in which people engage in
self-harm activities that are
not likely to be fatal—what
some people call “cry for help”
gestures). The patients were
receiving dialectical behavior
therapy, which emphasizes
mindfulness meditation as
a way to address emotion
dysregulation. At the same
time, she was studying sexual
difficulties among women who
had survived gynecologic
cancer. It struck her that the
two groups shared similarities:
a lack of sense of self and
feeling disconnected from
their bodies. If mindfulness
could help those with suicidal
thoughts, Brotto wondered,
might it also help cancer
survivors feel connected
● F E B R UA R Y 2 0 1 9 31
Cover Story | CE Corner

and present during sexual men with situational erectile dys- factors are clear risk factors and describes gendered anatomy.
encounters? function (The Journal of Sexual for sexual dysfunction, and “That script might not apply to
The intervention Brotto Medicine, Vol. 15, No. 10, 2018). both women and men with the people who are gender diverse or
developed involves eight weekly She’s now studying the inter- condition should be offered psy- nonbinary,” she says. “It’s import-
sessions delivered in a group vention in men with premature chosocial evaluation in addition to ant not to assume that someone
format. The treatment is similar to ejaculation, as well as in prostate medical evaluation and treatment, has a penis or clitoris or, even if
mindfulness-based cognitive ther- cancer survivors. when appropriate (The Journal they do, that they describe their
apy, Brotto says, but tailored for a “Adapting mindfulness to of Sexual Medicine, Vol. 13, bodies in this manner,” she adds.
sexual context. Patients learn how ABOUT CE sexual problems has really been No. 2, 2016). A more inclusive script would talk
to tune in to erotic sensations, for “CE Corner” is helpful for both men and women,” Even when a man’s sexual about clients’ bodies using words
a continuing-
instance, and how to integrate the says Stanley Althof, PhD, profes- dysfunction can be treated with they themselves would use.
education article
techniques into sexual encoun- offered by APA’s
sor emeritus at Case Western medications like Viagra, he can There’s also growing
ters back in the bedroom. Office of CE in Reserve University in Cleveland experience psychological awareness that sexual- and
In a series of controlled trials Psychology. and executive director of the consequences that also need to gender-minority people who
over the years, she and her Center for Marital and Sexual be addressed. “A man with a experience sexual dysfunction
To earn CE credit,
colleagues have demonstrated Health of South Florida. “It’s sexual problem is likely to have may have complicating factors
after you read this
the effectiveness of mindful- article, complete
been one of the most significant issues of self-esteem, lack of that need to be addressed in
ness-based sex therapy, not an online learning changes in the field.” confidence and perhaps avoiding treatment. “In many cases, sex-
only among gynecologic cancer exercise and intimacy,” says David Rowland, ual- and gender-minority patients

2 PSYCHOTHERAPY
survivors but also for people with take a CE test. PhD, a professor of psychology at experience a lot of the same
Upon successful
other sexual disorders. Recently, INTERVENTIONS Valparaiso University in Indiana problems that any majority group
completion of
for instance, they tested the the test—a score
OVER MEDICATIONS and past editor-in-chief of the Researchers are increasingly studying the span of human would experience in terms of
intervention in a small pilot study of 75 percent or Viagra, the first FDA-approved Annual Review of Sex Research. sexuality and gender identity, including transgender and sexual functioning. But they are
of women with low sexual desire oral treatment for erectile dys- “Most sex therapy in men is often dealing with an added layer
higher—you can
immediately print
gender nonbinary people, those in same-sex relationships
and arousal—the most common function, hit the market in 1998. directed toward the fallout that of discrimination and marginaliza-
sexual complaint in women, and your certificate.
Two decades later, there’s still a occurs because of a sexual
and people in nonmonogamous relationships. tion,” Peterson says.
one with few treatment options. To purchase the
big emphasis on pharmacological problem.” Portrayals of transgender
Participants reported significant online program visit treatments for sexual problems, In men, sexual desire is bodies are often presented in
improvements in sexual desire, www.apa.org/ed/ notes Cynthia Graham, PhD, a strongly influenced by testos- Althof says. But pharmaceuticals “There’s been a trend toward demeaning or hypersexualized
sexual function and sex-related ce/resources/ce- professor of sexual and repro- terone, Rowland notes. But in alone won’t cure most sexual expanding inclusivity,” Vencill ways in popular culture, which
corner.aspx.
distress after the treatment (The ductive health at the University women, sexual dysfunction is disorders. “We must take the says, to include the full span of can contribute to negative feel-
The test fee is
Journal of Sex Research, Vol. 54, $25 for members
of Southampton in England often more complex. “Sexual psychology, the culture and human sexuality and gender ings that transgender people
No. 7, 2017). and $35 for and editor of The Journal of desire in women is more likely the relationship into account,” identity, including transgender have about their own bodies and
Mindfulness-based sex nonmembers. Sex Research. Drug companies driven by a desire for intimacy, he says. and gender nonbinary people, sexuality. “In that case, treatment
therapy is now used around the For more have introduced multiple Viagra feeling close and valued,” he those in same-sex relationships might involve CBT interventions

3
information, call
world, and several other research competitors for men, and in 2015, says. “It’s a common saying— EXPANDING and people in nonmonogamous to address sexual functioning,
(800) 374-2721.
groups are testing it in various the FDA approved the drug Addyi though not entirely accurate—that INCLUSIVITY relationships. but it might also involve chal-
populations. A meta-analysis by As an APA member, (flibanserin) to treat low sexual men just need a place to have Historically, sex therapy has been Vencill’s work focuses on lenging and countering negative
Kyle Stephenson, PhD, found take advantage of desire in premenopausal women. sex and women need a reason.” rooted in a traditional view: cis- adapting sex therapy tools to be messages that the individual
evidence that mindfulness-based your five free CE Meanwhile, however, psychol- That may help explain why sales gender, heterosexual encounters more relevant to transgender and has internalized as a result of
credits per year.
therapy was effective for treat- ogists are demonstrating that of flibanserin have been disap- between a man and a woman. gender-diverse clients. For exam- lifelong exposure to transphobia,”
Select the free
ing female sexual dysfunction online programs
more focus should be put on psy- pointing—and why, Rowland says, Even within that already narrow ple, she says, using the Masters Peterson says.
(The Journal of Sex Research, through your chological interventions, which psychosocial interventions such definition, sex therapy has mostly and Johnson sex therapy tech- While diversity and inclusiv-
Vol. 54, No. 7, 2017). Brotto and MyAPA account. have proven to be effective. as CBT and mindfulness-based been available to white, middle- nique of “sensate focus,” couples ity in sex research are gaining
colleagues have also begun In a consensus statement from sex therapy usually remain the and upper-middle-class married take turns touching one another momentum, there’s been little
RAWPIXEL/GETTY IMAGES

applying mindfulness to men’s the 2015 International Consulta- best choice for women. couples. Increasingly, though, as they learn how to better tune yet in the way of published evi-
sexual disorders, finding in a tion on Sexual Medicine, Marita Of course, both men and researchers who study sexuality in to physical sensations in the dence about how best to treat
feasibility pilot study that the McCabe, PhD, and colleagues women with sexual dysfunction and sex therapy are taking a body. But the traditional sensate these populations, Peterson and
approach has promise for treating concluded that psychosocial should rule out biological causes, broader perspective. focus script is very heterosexual Vencill say. But they predict that

32 M O N I TO R O N P S YC H O LO G Y ● F E B R UA R Y 2 0 1 9 M O N I TO R O N P S YC H O LO G Y ● F E B R UA R Y 2 0 1 9 33
Cover Story | CE Corner
More research is looking at both individual
and relational data in studies of sexual
dysfunction—and findings are starting to
inform the way sex therapists treat patients.
this will be an important area for
future research. “What do we do
to make our existing sex therapy
techniques relevant for people
who are not part of a heterosex-
ual, cisgender couple?” Vencill
asks. “We have to make sure the
techniques we use are applicable
and generalizable.”
4 THE COUPLE’S
PERSPECTIVE
It’s hardly a new discovery
that it takes two to tango, but
most studies have focused on
sexual problems at the individual
level—especially research on
interventions for those problems.
Increasingly, researchers are
looking more closely at the role
of partners. “Sexual dysfunction is
often seen as an individual prob-
lem, when of course it’s so often a
couple’s issue,” says Graham.
When one partner has sexual
34 M O N I TO R O N P S YC H O LO G Y
dysfunction, it can make sex more
stressful and less pleasurable for
his or her partner. “No wonder
that would impact sexual desire,”
Vencill says. In a review of the lit-
erature for the 2015 International
Consultation on Sexual Medicine,
Brotto and colleagues found stud-
ies consistently demonstrating
that dysfunction in one partner
often contributes to problems
in sexual satisfaction as well as
sexual functioning for the other
partner (The Journal of Sexual
Medicine, Vol. 13, No. 4, 2016).
Now, more researchers are
beginning to look at both individ-
ual and relational data in studies
of sexual dysfunction, Vencill
says. For instance, among hetero-
sexual women who experience
pain during intercourse, sympa-
thetic partners might be inclined
to stop a sexual encounter that
becomes painful. Yet research
● F E B R UA R Y 2 0 1 9
HIGHER DEGREE OF COMMITMENT TO YOU
by Natalie Rosen, PhD, and col- messages can create a lot of psychologists have a huge
leagues shows that women with stress.” role to play in assessing,
these sympathetic or “solicitous” At the same time, many treating and managing these
partners have greater pain inten- people still balk at the idea problems.”
sity and poorer sexual satisfaction of seeking help for their While most psychologists’
compared with women with sexual problems. That’s one training gives them a strong
FURTHER partners who encourage them reason that sex therapists are foundation for treating sexual
READING to adapt and find ways to create optimistic about the devel- difficulties, sex-specific train-
sexual intimacy without engaging opment of telepsychology ing is valuable, especially as it
Better Sex in the activity that is painful (The and web-based interventions. helps psychologists confront
Through Journal of Sexual Medicine, McCabe and Catherine Con- their own beliefs, biases and
Mindfulness
Brotto, L.A. Vol. 9, No. 9, 2012). naughton, PhD, at Australian discomfort around sex. “We
Greystone Books, Such findings are starting to Catholic University, described live in a very sexualized cul-
2018 inform the way sex therapists internet-based approaches to ture, but many of us haven’t
treat patients and their partners, sex therapy in a chapter in the been taught to have healthy
The Wiley Vencill says. “Moving forward, 2017 “Wiley Handbook of Sex conversations around sexu-
Handbook of
Sex Therapy more research on the role of Therapy.” They concluded ality or are even taught much
Peterson, Z.D. (Ed.) partners in sexual functioning and that more research is needed, about our bodies in a scien-
Wiley-Blackwell, satisfaction is really critical.” though early studies have tifically accurate way,” Vencill
2017 shown cybertherapy to be says. “Where the extra train-
Principles and
5 CHANGING ATTITUDES
TOWARD SEX
effective for treating a variety
of sexual problems in men
ing comes into play is around
sexual knowledge, values and
THE MIND IS A POWERFUL TOOL.
SO IS THIS DEGREE.
Practice of Sex
Therapy, 5th ed. In some ways, sex is less taboo and women. attitudes.”
Binik, Y.M., & Hall, than it was when Masters and Digital interventions can For those interested in
K.S.K. (Eds.) Johnson began their research. build a bridge to people who learning more, the Ameri-
Guilford Press, 2014 Practitioner-scholar model of training with a
“There’s a much greater open- have reservations talking can Association for Sexuality
curriculum grounded in theory and research
Sexual ness” in younger generations about sex in person. “There Educators, Counselors and
to talk about sex and sexuality,
and real-world experience, taught by educators
Dysfunction are a lot of people out there Therapists offers continuing
in Men Rowland says. “The conversations with sexual problems who education and certification who genuinely care about your success.
Rowland, D.L. are very different today than they would never feel comfortable for sex counselors, therapists PsyD in Clinical Psychology programs are
Hogrefe, 2012 accredited by the American Psychological
were 20 or even 10 years ago.” sitting face-to-face and talking and educators. The Society
Nonetheless, sex is still a topic about their sexuality or their for Sex Therapy and Research Association (APA), certifying that they meet
Psychosexual
Therapy in that makes people uneasy. “Cul- sexual problems,” Peterson also offers resources for the industry’s rigorous standards.
Perspective: turally, we have a lot of anxiety says. professionals, including
Strategies for the around sex,” Vencill says. psychologists, with clinical or
Non-Specialist C LI N I C A L. A R G OSY. E D U/ M O N I TO R
In the United States (and LOOKING AHEAD research interests in human
Counselor
Rowland, D.L., & many other cultures), sex often There’s another trend that sexual concerns.
Gutierrez, B. involves mixed messages. “You sex therapists would like to Researchers, too, can find
In “Psychotherapy: can joke about sex, but you’re not see: Many say they wish more much to explore in the fields
Methods, Outcomes supposed to talk about how it’s psychologists would take a of sexual functioning and sex-
and Future
really going—especially if you’re greater professional interest uality, Althof adds. “There’s
Directions,”
D. Brewer (Ed.) having problems,” Peterson says. in sex and sexuality. sexual dysfunction, gender
Nova Science, 2016 “On the other hand, there are all “So many aspiring psychol- issues, the effect of illness
Programs, credential levels, technology, and scheduling options vary by school
these messages suggesting we ogists and graduate students I and aging on sexuality,” he and are subject to change. Not all online programs are available to residents of
PEOPLE IMAGES/GETTY IMAGES
all U.S. states. © 2018 Argosy University. All rights reserved. Our email address is
should be having these amaz- talk to think that sexual health says. “There’s often a reluc- materialsreview@argosy.edu See auprograms.info for program duration, tuition,
fees and other costs, median debt, alumni success, and other important info.
ing sex lives. We’re inundated in is in the domain of medicine,” tance to embrace this very The Doctor of Psychology in Clinical Psychology Program at Argosy University,
Atlanta, Chicago, Hawaii, Orange County, Phoenix, Tampa, Twin Cities and Northern
the popular culture with these Brotto says. “But the bulk of important piece of people’s Virginia is accredited by the Commission on Accreditation of the American
Psychological Association (APA).Questions related to the program’s accredited
status should be directed to the Commission on Accreditation: Office of Program
very narrow messages about treatment for sexual dysfunc- lives. But it’s a vital field with Consultation and Accreditation, American Psychological Association, 750 1st
Street, NE, Washington DC 20002 Phone: (202) 336-5979 / E-mail: apaacred@
what ‘good sex’ is, and those tion is psychological, and so many things happening.” ■ apa.org / Web: www.apa.org/ed/accreditation. Campuses enrolling new students.
M O N I TO R O N P S YC H O LO G Y ● F E B R UA R Y 2 0 1 9 35